Provider Demographics
NPI:1184746695
Name:SHANOWER, TIFFANY M (LISW)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:M
Last Name:SHANOWER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 HOWENSTINE DR SE
Mailing Address - Street 2:
Mailing Address - City:EAST SPARTA
Mailing Address - State:OH
Mailing Address - Zip Code:44626-9595
Mailing Address - Country:US
Mailing Address - Phone:330-936-9303
Mailing Address - Fax:
Practice Address - Street 1:130 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2934
Practice Address - Country:US
Practice Address - Phone:330-343-6600
Practice Address - Fax:330-343-6405
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.08003551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH182173Medicaid
OH182173Medicaid